Research Article: Mothers’ education and ANC visit improved exclusive breastfeeding in Dabat Health and Demographic Surveillance System Site, northwest Ethiopia

Date Published: June 28, 2017

Publisher: Public Library of Science

Author(s): Amare Tariku, Kassahun Alemu, Zemichael Gizaw, Kindie Fentahun Muchie, Terefe Derso, Solomon Mekonnen Abebe, Mezgebu Yitayal, Abel Fekadu, Tadesse Awoke Ayele, Geta Asrade Alemayehu, Adino Tesfahun Tsegaye, Alemayehu Shimeka, Gashaw Andargie Biks, Jacobus P. van Wouwe.


Despite its proven benefit in reducing child mortality and morbidity, the coverage of exclusive breastfeeding (EBF) remains sub-optimal. In Ethiopia, about 52% of infants under six months of age were exclusively breastfed, implying the need for further identification of the barriers to optimal EBF practice. Therefore, this study aimed to investigate EBF and its determinants in the predominantly rural northwest Ethiopia.

The study was conducted at the Dabat Health and Demographic Surveillance System (HDSS) site, which is located in Dabat District, northwest Ethiopia. A total of 5,227 mothers with children under five years of age were included for analysis. Multivariable binary logistic regression analysis was employed to identify factors associated with EBF. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A P-value of <0.05 was used to declare statistical significance. About 54.5% [95% CI: 51.9, 57.1] of the mothers practiced EBF. Mothers' education [AOR = 2.10; 95% CI: 1.63, 2.71], age (20–35 years) [AOR = 1.39; CI: 1.07, 1.80], urban residence [AOR = 1.28; 95% CI: 1.07, 1.54], at least one ANC visit [AOR = 1.41; 95% CI: 1.23,1.61], initiation of breastfeeding within one hour of birth [AOR = 1.32; 95% CI: 1.15,1.50], richer household [AOR = 1.34; 95% CI: 1.07, 1.65], and withholding prelacteal feeds [AOR = 1.34; 95% CI: 1.17, 1.53] were found important determinants of EBF. In this study area, the prevalence of EBF is lower than the national as well as the global recommendation for universal coverage of EBF. Therefore, strengthening the implementation of Infant and Young Child Feeding strategy (IYCF) and maternal health care utilization are essential for stepping up EBF coverage. Moreover, attention should be given to uneducated, rural resident, and adolescent mothers.

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Exclusive breastfeeding (EBF) is an ideal way of achieving optimal child growth and development [1,2]. Because of an adequate amount of omega-3 poly-unsaturated fatty acids and other bioactive ingredients in the mother’s milk, EBF improves the brain development of the child, its intelligence and the capacity to learn [3–6]. Globally, EBF is noted as a major child survival strategy [1,2], provided that the implementation of optimal EBF is guaranteed with a significant reduction in the risk of morbidity and mortality for a decade [1,7,8]. Decreased odds of acquisition of infectious diseases, such as pneumonia [8], diarrhea [7, 9] and upper respiratory tract infection [10,11] are particularly documented among exclusively breastfed children. Besides, a prolonged duration of EBF is protective against the risk of non-communicable diseases, like asthma and other allergic related respiratory infections [12,13], celiac diseases [14,15], atopic dermatitis [13], and diabetes mellitus [16]. Furthermore, it provides emotional and psychological benefits by stepping-up the mother-child bonding [17].

A total of 5,227 mothers with children aged under five years were included in the study. Two-third (65.3%) of the mothers were aged 20–34 years. Of all mothers, 3313 (63.4%) were illiterate, while only 729 (13.9%) attended secondary school and above. A total of 3940 (75.4%) mothers were rural inhabitants, and 4481 (85.7%) were married at moment (Table 1). Among the total, 3332 (67.7%) of the mothers had at least one ANC visit for the index child and 3135 (63.7%) of them were not currently using any contraceptive methods. Almost all, 5,175 (99.01%) of the mothers breastfed their index children at least once in the child’s life. Furthermore, early initiation of breastfeeding was reported by 2282 (44.1%) mothers, and prelacteal feeding by 3,054 (58.4%).

This study demonstrated that the proportion of mothers who exclusively breastfeed their infants for six months was lower than the national as well as the global recommendation for a universal coverage of EBF. Mothers’ age, residence, educational status, ANC visit, initiation of breastfeeding, prelacteal feeding, and household wealth status were the key determinants of EBF.

The prevalence of EBF in the predominantly rural northwest Ethiopia was lower than the national as well as the global recommendation for the universal coverage of EBF. EBF was significantly associated with socio-demographic and health care utilization related characteristics. Moreover, inappropriate neonatal feeding practices were correlated with non-EBF practice. Therefore, strengthening the implementation of the IYCF strategy and maternal health care utilization is essential to increase EBF coverage. Moreover, interventions aiming to promote IYCF knowledge and practice of mothers should pay attention to the uneducated, rural resident and adolescent mothers.